| NPI | 1275095655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME175261) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 1017950) |
| Enumeration Date | 2019-04-03 |
| Last Update Date | 2025-07-21 |